Tuesday, June 09, 2009

Glulten Sensitivity and Celiac Hepatitis

What follows is an excerpt from our book The Gluten Effect:

“A relatively new term, “celiac hepatitis” refers to a number of conditions wherein the liver is affected by gluten sensitivity. Celiac hepatitis does not simply mean that you have celiac disease, as any form of gluten sensitivity places one at risk for liver dysfunction. Liver changes can be mild, with abnormal blood testing and no symptoms, or the changes can be severe, with cirrhosis and liver failure. Predominantly liver dysfunction in gluten sensitivity is felt to be related to auto-immune mechanisms …, intestinal leakage with exposure to foreign proteins and infections, or antibody mimicry attacking the liver.”

“Despite sixteen percent of patients with autoimmune liver disease having gluten sensitivity, routine evaluation for this disorder is not prescribed.”

“Symptoms of celiac hepatitis can be vague at times. Fatigue may be the only symptom. Other symptoms can include lightheadedness, abdominal discomfort, joint pains, skin itchiness, nausea and vomiting. If liver dysfunction is more significant, anemia and a yellowing of the skin, called jaundice, can develop.”

“Several studies have assessed the occurrence of liver dysfunction in gluten sensitivity. Most of the time, symptoms are either mild or absent, and the most common abnormal finding is elevation of liver enzymes during routine blood testing, rather than symptoms.”

“In forty percent of people with gluten sensitivity, elevated liver enzymes are found during routine blood testing. In addition, all of these individuals respond to a gluten-free diet with normalization of liver enzymes within weeks to months. These findings have been repeatedly verified. It is therefore strongly recommended that all individuals with elevated liver enzymes be evaluated for gluten sensitivity.”

“Frustratingly, we usually find that patients who have elevated liver enzymes without severe symptoms are almost always told to just wait and see what happens at their next annual physical. The idea of waiting a year or more while gluten reactions continue to irreversibly damage the body is a practice we hope to change by increasing the medical profession’s awareness of gluten intolerance.”

9 comments:

I have a friend who has elevated AST and ALT counts. I would like to make sure my friend receives good quality care, so I would like to recommend that the doctors screen for gluten sensitivity.

You mentioned in the comments on another post the following:

"I would recommend two tests. Tissue transglutaminase is good as a celiac screen but if it's negative it's really only telling you that you don't have severe villous atrophy. Moderate to mild villous atrophy rarely shows up positive in this test.

Secondly I would recommend a gliadin antibody test. This picks up the immune system's reaction to gliadin even when severe celiac isn't present."

Is this the same recommendation you would make for screening someone with high liver values? In that same thread, someone else followed up with:

"If you do get an antigliadin antibody test, both AGA IgG and AGA IgA, be sure the lab does not substitute the deamidated AGA test. Some labs are using the deamidated test because that corresponds well with villous atrophy."

Basically I think you have a good plan for your friend.To summarize the testing:For celiac use the tTG and deamidated gliadin.For gluten sensitivity use the AGA both IgA and IgG.

Do remember that the liability of all these tests remains a lack of sensitivity so don't forget my "gold standard" - eliminating gluten and feeling better! Regardless of the results if your friend feels better off gluten I would recommend 3 months minimally gluten-free and then restest the liver enzymes.

Lastly, I just returned from a conference with clinical nutritionists from around the world and new testing is about to be released that will assess any antibodies being made to various organ systems of the body. These tests would show the body's tendency to be moving toward an autoimmune disease. The beauty is that the patient will know which system gluten is attacking as all too often such problems are completely asymptomatic...much like elevated liver enzymes.

Hello, do you know of anyone doing any research on the connection between PCOS and CD? I have been diagnosed with PCOS via bloodwork, symptons, and the pearl cluster of cysts, many years ago. Finally conceived twins after 6 years of fertility treatments, via IVF. I watched a program on CD just the other night and I was stunned to realize I have suffered with all of the symptoms for years of my life. I just never knew what CD was. I am obse since I have a hard time loosing weight with the PCOS, but my weight gain did not happen until my very late 20's, and almost all within one year (I gained 65 lbs in less than one year). Doctor's refuse to test me due to my weight, telling me CD sufferers are not overweight. Is this true? Should I rule out CD or insist on tests? And again, anyone doing any research on the connections between the two diseases? If not, why not?

Almost 40% of people who are diagnosed with CD are obese and I am one of them. When I was in my 20's, I asked my doctor to test and he said no, you wouldn't be heavy. So, I went through Hashimoto's Thyroiditis which became papillary carcenoma, iron deficient anemia, have all of my life struggled with what they said was IBS, etc. Now, at the age of 52 I have finally been diagnosed. I have only been totally gluten free for two months now, but I can already tell the difference. Had I known back then, I could made the change to my diet and had potentially avoided a lot of unnecessary pain, radiation, and surgery. Don't take no for an answer....

I also have PCOS and I have the celiac gene, I was told I do not have active celaics, however when I stop eating it I feel better when I eat it I suffer with....Reflux, nausea, Diarrhoea, Skin rashes, ulcer etc etc. So I have it and no one will tell me other wise. To the lady with PCOS don't listen to Dr's they are only good at one thing KILLING YOU!

I am concerned that untreated gluten sensitivity issues can lead to pancreatic cancer since liver problems can be involved. I had a sister and mom who had panc. cancer-- sister is alive (over 10 yrs ago) but mom died at age 82. If I knew then what I know now, I would have had them checked for gluten sensitivity.I too am gluten sensitive but so far not celiac.

I have a 15 year old daughter who has been suffering with frequent severe upper abdominal pain, vomiting, and elevated enzymes for over two years. She missed half of each school year over the past two years. She was thin before but is very thin now. We exhausted the specialists in Wichita and Kansas City with no success on diagnosing her condition. The episodes last 1-4 weeks and then go away on their own. We moved to Houston in the hopes of getter better care for her but they are stumped. Plus, it takes three months to get in to see anyone unless the episode gets so bad we have to take her to the emergency room. We have been told there are physicals indications of glutton damage in her small intestine but all the tests come back negative. There are no other food allergies. I seem to think glutton is the problem but specialists we take her to can't seem to figure it out and some of them are considered some of the best. We are just very frustrated that no one seems to be able to figure out what is wrong with her.

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Who Are We?

The Gluten Doctors are a group of doctors consisting of MDs, Naturopaths and Certified Clinical Nutritionists.

Two of the doctors, Drs. Rick and Vikki Petersen, authored the bestseller, "The Gluten Effect", a book which exposes the dangers of gluten and provides a path to good health for those with gluten sensitivity.

The Gluten Doctors specialize in the area of digestive problems, especially gluten sensitivity and celiac disease. Their clinic, HealthNOW Medical Center, is located in the heart of Silicon Valley in Sunnyvale, California.